Salah Samer, Toubasi Samar
Department of Medical Oncology, King Hussein Cancer Center, Al-Jubeiha 11941, Amman, Jordan.
Department of Clinical Nursing, The University of Jordan, Al-Jubeiha 11942, Amman, Jordan.
Mol Clin Oncol. 2015 Jan;3(1):157-162. doi: 10.3892/mco.2014.426. Epub 2014 Sep 24.
Pulmonary metastasectomy (PM) is associated with improved survival of patients with metastatic osteosarcoma; however, the factors affecting survival following achievement of complete surgical remission remain controversial. The main objective of this study was to report the outcomes and prognostic factors of osteosarcoma patients who achieved complete remission (CR) following PM. We analyzed the effect of demographic and disease-related characteristics on the overall survival (OS) of consecutive patients with metastatic osteosarcoma who were treated at a single institution and achieved CR following PM, through univariate and multivariate analyses. Between January, 2000 and August, 2013, 62 patients with metastatic osteosarcoma were treated and followed up at our institution. A total of 25 patients achieved CR following PM and were included in this analysis. The 5-year OS and disease-free survival following PM were 30 and 21%, respectively. The factors correlated with inferior OS in the univariate analysis included chondroblastic subtype, post-chemotherapy necrosis <90% in the primary tumor, metastasis detected during neoadjuvant or adjuvant chemotherapy and pathological identification of tumor cells reaching the visceral pleural surface of any of the resected nodules. In the multivariate analysis, the chondroblastic subtype was the sole independent adverse prognostic factor (HR=4.6, 95% CI: 1.0-21.3, P=0.044). Therefore, factors associated with tumor biology, including poor tumor necrosis in the primary tumor and detection of metastasis during primary chemotherapy, are associated with poor post-metastasectomy survival. In addition, chondroblastic subtype and visceral pleural involvement predicted poor prognosis in our series.
肺转移瘤切除术（PM）与转移性骨肉瘤患者生存率的提高相关；然而，在实现完全手术缓解后影响生存的因素仍存在争议。本研究的主要目的是报告骨肉瘤患者在PM后实现完全缓解（CR）的结果及预后因素。我们通过单因素和多因素分析，分析了人口统计学和疾病相关特征对在单一机构接受治疗且在PM后实现CR的连续性转移性骨肉瘤患者总生存（OS）的影响。2000年1月至2013年8月期间，62例转移性骨肉瘤患者在我们机构接受治疗并随访。共有25例患者在PM后实现CR并纳入本分析。PM后的5年OS率和无病生存率分别为30%和21%。单因素分析中与较差OS相关的因素包括软骨母细胞亚型、原发肿瘤化疗后坏死<90%、新辅助或辅助化疗期间检测到转移以及任何切除结节的肿瘤细胞病理检查发现累及脏层胸膜表面。多因素分析中，软骨母细胞亚型是唯一独立的不良预后因素（HR=4.6，95%CI：1.0-21.3，P=0.044）。因此，与肿瘤生物学相关的因素，包括原发肿瘤坏死不佳和原发化疗期间检测到转移，与转移瘤切除术后生存不良相关。此外，在我们的系列研究中，软骨母细胞亚型和脏层胸膜受累预示预后不良。
